FAQ

What is it?
Why have I not heard of this before, is point of care medication dispensing a new concept?
The practice of physician in-office dispensing has been around since physicians began practicing medicine; but a re-emergence as an industry began in the early 1980’s. In 1983, a nationwide campaign lead by the retail pharmacy industry was started with the intent to eliminate the physician’s rights to dispense. In 1985, legislation in Congress was passed in 46 states to secure the physician’s rights to dispense FDA approved medications to their own patients. The 1990’s dispensing systems were developing to make the process fast, easy and cost effective for the physician and now in the 2000’s with reimbursement cut backs to physicians and only a limited amount of time to see patients which decreases the chance of a physician increasing his patient load, physicians are turning to ancillary services such as in-office dispensing to help increase their profit margins. As well the old “prepackaged generic “cash and carry model was too labor intensive and it forces the Physician to “sell” medications. The Dr. Automate program allows Physicians to write a prescription and let the patient know they can “fill their prescription at the in-office pharmacy or they can go to a retail pharmacy”, either way the patient can use their insurance card or pay cash for their prescription and it will cost the patient the same. However when the patient picks up their prescription at a retail pharmacy, the office loses significant revenue opportunities and possibly increases staff workload due to pharmacy and patient phone calls, faxes, etc. Worst of all the retail pharmacy captures the additional income.

Legal & Regulatory

The # 1 question asked by physicians concerning physician in-office dispensing: Is it legal?
Yes, every physician is allowed by law to dispense medications to his/her own patients within the practice environment. Under Stark regulations, physician dispensing is considered acceptable when the dispensing is limited to the physician’s own patients; and the medications and products dispensed meet FDA guidelines for re-packaging and labeling. There are only five states (Massachusetts, Montana, New York, Utah, and Texas) that have more restrictive laws concerning point of care dispensing; it is allowed, but limited.
What is Stark law? How does this affect me if I become a dispensing practitioner?
Stark law pertains to physician self-referral for Medicare and Medicaid patients. There are exemptions to this status for in-office ancillary services including physician dispensing. The in-office ancillary services exception of Stark law permits physician owners of a medical group, and other members of the group, to refer patients to their group for certain Designated Health Services (DHS). An outpatient prescription drug given to a patient in the physician’s office, but taken by the patient at home, is now covered by the in-office ancillary services exception.

To qualify for protection under the in-office ancillary services exception, the DHS must be furnished personally by the referring physician or another physician member in the same group practice or by individuals who are “directly supervised” by the referring physician or group practice member. The in-office ancillary services must be furnished in the same building in which the referring physician or a group practice member furnishes substantial physician services unrelated to the furnishing of DHS.

Does the physician need a special license to dispense medications in the office?
Most states do not require anything beyond your existing DEA and State license in order to dispense medications. There are a few states that have a designated dispensing license. In most cases it is offered at a minimal cost. Dr. Automate will help you in assuring you have all proper licensure to participate in your state.
What liability does the physician practice assume with in-office dispensing?
The liability is the same as it would be when a physician writes a prescription that is filled by a retail pharmacy. In physician in-office dispensing, there are stringent guidelines concerning packaging and labeling of the FDA approved medications. The Dr. Automate program meets state and federal requirements.
Does physician in-office dispensing comply with state and federal drug dispensing regulations?
The Dr. Automate dispensing program complies with state and federal requirements.
Financial
How much will physician in-office dispensing cost my practice?
The Dr. Automate program requires a reasonable enrollment fee, which pays for everything you will need to become an in-office dispensing pharmacy. We do all the heaving lifting for you. The Dr. Automate team will credential the entire practice to electronically process pharmacy claims through the respective insurance payer. This means that regardless of the number of physicians within the practice all prescriptions written at that location will be eligible for electronic claims adjudication. We have found that this small investment is quickly recouped within the first few months of dispensing.

Liability

Will dispensing cause my malpractice premiums to increase?
No, whether a physician prescribes medications that are filled at a retail pharmacy or at his practice, the physician’s responsibility is the same. Malpractice carriers do not charge higher rates for dispensing physicians.
Staff & Training
Who can dispense the medications in our office? Will I need a pharmacist, additional staff or a pharmacy tech to dispense?
In most states, a directive from the physician allows other staff members to dispense medications within the office. A few states do require that the physician actually do the dispensing. Check with your state pharmacy or medical board for details.
How do I prescribe medication?
The liability is the same as it would be when a physician writes a prescription that is filled by a retail pharmacy. In physician in-office dispensing, there are stringent guidelines concerning packaging and labeling of the FDA approved medications. The Dr. Automate program meets state and federal requirements.
What if we have multiple physicians in our practice?
Having multiple physicians in a practice is not a problem, as each physician is assigned a specific password and can track their dispensing history separately for bookkeeping, documentation or patient information purposes. You can also have security access assigned at different levels to approved staff members who will be assisting in the dispensing process. Having additional physicians within the practice can help generate significantly more income.
Is the Dr. Automate software program easy to use? Will Dr. Automate train my staff and how long will the training take?
Our dispensing software is easy to utilize, requires minimal training time, is easy to navigate and insures an accurate dispense. This software is utilized in over 10,000 locations nationwide. It features a drug utilization review for possible contraindications, allergies, conditions etc. as well as generates bottle labeling and patient education printouts. State mandated reporting is also compiled and submitted by the intuitive software. Dr. Automate will provide complete training on the software and we offer a dedicated account manager as well as an 800 number for technical support if you have questions about the software or filling a prescription.
Is physician in-office dispensing efficient? How much time will it take a pharmacy tech or trained staff member to dispense a medication?
The Dr. Automate dispensing program is easily integrated into your office procedures and patient flow. Filling a prescription can generally be completed between 30 seconds to 2 minutes.
Patients
How will physician in-office dispensing benefit my patients?
First and foremost is the convenience and time saving elements for your patients. No longer will they have to make an additional trip or wait in long lines at a retail pharmacy to fill prescriptions. Filling prescriptions from your practice is an added service to your patients that saves them time and adds no additional cost. In many cases this can also mean a cost savings to the patient because no extra commute is required.
What if patients ask about our pricing versus their retail pharmacy?
The Dr. Automate system communicates using the same technology that any major retail pharmacy uses in order to process a pharmaceutical insurance claim through the insurance payer. This allows for instant electronic confirmation of eligibility, patient copay and reimbursement to the practice. Therefore, a patient’s copay for brand or generic product is exactly the same as if they had gone to the pharmacy.
Billing & Copays
How do I set pricing for generic cash & carry medications?
Dr. Automate supplies medications to our clients at an everyday low price designed to help provide the in-office dispensary with a strong margin potential. Each practice can set their own generic customer cash pay pricing based on retail competition as well as in-office financial best practices. The patient simply pays the physician’s office the amount that the office has set to charge for those cash pay medications. You are in control.
Can I process Medicare or Medicaid Claims?
Yes when the state allows or there is a part D supplement and/or medications that are covered by a third party insurance payor such as BC/BS, Caremark, Medco, etc.
Will your system work for workers comp dispensing?
Yes Dr. Automate and the program can help you when dealing with workers comp dispensing.
Can I use manufacture cash offset or co-pay assistance cards?
The Dr. Automate adjudication software allows you to utilize manufacturer cash offset and co-pay assistance cards the exact same way they are used at a retail pharmacy.
Workstation
How much space is required to have a mini-pharmacy?
Minimal space is required to dispense. You will need store your medications in a locked cabinet and some medications are required to be in a locked cabinet in a locked room. The physical space required to fill prescriptions varies depending on the size of the practice, patient flow and space available. We install a full system medication cabinet, and any other necessary supplies and technology for efficient workflows.
Information Technology
Does the Dr. Automate program have a patient database with dispensing history?
Yes, patients are loaded in the database automatically when you dispense a medication and you can pull reports on dispensing history by patient, medication, date, etc.
How much time will it take to enter a new patient into the database?
A new patient can be added within 30 seconds to 2 minutes while dispensing. Other demographic information is built into the system and can be added at time of dispense or at a later date if desired.
Pharmacuetical Management
Does the Dr. Automate program have an inventory tracking process?
The Dr. Automate program will automatically tell you when a particular medication is below pre-set levels that are determined by each individual office at the time of installation and training.
How do we re-order medications?
Our Staff and software will project the dispensaries need based on patients coming in that following week. We will then send you a request for purchase, with details on what is to be dispensed or potentially dispensed along with variable numbers of unanticipated new patient dispenses. the following week, and will order based on those projections.
What about theft?
The Dr. Automate dispensing process is managed in such a way that theft is rarely a problem. Firstly the Medication Cabinet has a bluetooth padlock, and has audit logs of who is going in and out of the cabinet. There is password protection on all devices, and an automatic inventory system, and dispensing records of who dispensed make it difficult to hide theft of medications. Every container is accounted for in the inventory system and the reports allow the staff to easily and quickly determine if there is a problem.

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